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psnet.ahrq.gov/node/44873/psn-pdf
March 21, 2016 - Malpractice Risks in Communication Failures: 2015
Annual Benchmarking Report.
March 21, 2016
Cambridge, MA: CRICO Strategies; 2016.
https://psnet.ahrq.gov/issue/malpractice-risks-communication-failures-2015-annual-benchmarking-report
Communication failures are known to contribute to medical errors. Analyzing more …
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cdsic.ahrq.gov/sites/default/files/2024-12/OY2_Final%20Stakeholder%20Center%20Operational%20Framework.pdf
January 01, 2024 - Planning Committee Meetings and Communications.
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psnet.ahrq.gov/node/38488/psn-pdf
March 18, 2009 - Intensive care units, communication between nurses and
physicians, and patients' outcomes.
March 18, 2009
Manojlovich M, Antonakos CL, Ronis DL. Intensive care units, communication between nurses and
physicians, and patients' outcomes. Am J Crit Care. 2009;18(1):21-30. doi:10.4037/ajcc2009353.
https://psnet.ahrq.g…
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psnet.ahrq.gov/node/45363/psn-pdf
September 14, 2016 - Effective perioperative communication to enhance patient
care.
September 14, 2016
Garrett H. Effective Perioperative Communication to Enhance Patient Care. AORN J. 2016;104(2):111-20.
doi:10.1016/j.aorn.2016.06.001.
https://psnet.ahrq.gov/issue/effective-perioperative-communication-enhance-patient-care
Poor team …
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psnet.ahrq.gov/node/60533/psn-pdf
May 27, 2020 - What constitutes effective team communication after an
error?
May 27, 2020
Hart WM, Doerr P, Qian Y, et al. What constitutes effective team communication after an error? AMA J
Ethics. 2020;22(4):E298-E304. doi:10.1001/amajethics.2020.298.
https://psnet.ahrq.gov/issue/what-constitutes-effective-team-communication-a…
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psnet.ahrq.gov/node/42104/psn-pdf
January 07, 2015 - Challenges to nurses' efforts of retrieving, documenting,
and communicating patient care information.
January 7, 2015
Keenan G, Yakel E, Lopez KD, et al. Challenges to nurses' efforts of retrieving, documenting, and
communicating patient care information. J Am Med Inform Assoc. 2013;20(2):245-51. doi:10.1136/amiajn…
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psnet.ahrq.gov/node/39541/psn-pdf
June 02, 2010 - Structured communication for patient safety in
emergency medical services: a legal case report.
June 2, 2010
Greenwood MJ, Heninger JR. Structured communication for patient safety in emergency medical services:
a legal case report. Prehosp Emerg Care. 2010;14(3):345-8. doi:10.3109/10903121003760788.
https://psnet.…
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psnet.ahrq.gov/node/837600/psn-pdf
June 29, 2022 - Handoffs and teamwork: a framework for care transition
communication.
June 29, 2022
Webster KLW, Keebler JR, Lazzara EH, et al. Handoffs and teamwork: a framework for care transition
communication. Jt Comm Qual Patient Saf. 2022;48(6-7):343-353. doi:10.1016/j.jcjq.2022.04.001.
https://psnet.ahrq.gov/issue/handoffs…
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psnet.ahrq.gov/node/46782/psn-pdf
January 24, 2019 - Patient perspectives on how physicians communicate
diagnostic uncertainty: an experimental vignette study.
January 24, 2019
Bhise V, Meyer AND, Menon S, et al. Patient perspectives on how physicians communicate diagnostic
uncertainty: An experimental vignette study. Int J Qual Health Care. 2018;30(1):2-8.
doi:10.1…
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psnet.ahrq.gov/node/47502/psn-pdf
June 02, 2019 - Failure to debrief after critical events in anesthesia is
associated with failures in communication during the
event.
June 2, 2019
Arriaga AF, Sweeney RE, Clapp JT, et al. Failure to Debrief after Critical Events in Anesthesia Is
Associated with Failures in Communication during the Event. Anesthesiology. 2019;130(…
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psnet.ahrq.gov/node/33567/psn-pdf
June 15, 2024 - Handoffs
June 15, 2024
Handoffs and Signouts. PSNet [internet]. 2019.
https://psnet.ahrq.gov/primer/handoffs
PSNet primers are regularly reviewed and updated by the UC Davis PSNet Editorial Team to ensure that
they reflect current research and practice in the patient safety field. Last reviewed in 2024.
Backgroun…
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psnet.ahrq.gov/node/40545/psn-pdf
June 22, 2011 - Using ORA to explore the relationship of nursing unit
communication to patient safety and quality outcomes.
June 22, 2011
Effken JA, Carley KM, Gephart SM, et al. Using ORA to explore the relationship of nursing unit
communication to patient safety and quality outcomes. Int J Med Inform. 2011;80(7):507-17.
doi:10.…
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psnet.ahrq.gov/node/44141/psn-pdf
November 06, 2015 - Failures in communication through documents and
documentation across the perioperative pathway.
November 6, 2015
Braaf S, Riley R, Manias E. Failures in communication through documents and documentation across the
perioperative pathway. J Clin Nurs. 2015;24(13-14):1874-1884. doi:10.1111/jocn.12809.
https://psnet.a…
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psnet.ahrq.gov/node/44070/psn-pdf
September 09, 2015 - Communication of vital signs at emergency department
handoff: opportunities for improvement.
September 9, 2015
Venkatesh AK, Curley D, Chang Y, et al. Communication of Vital Signs at Emergency Department Handoff:
Opportunities for Improvement. Ann Emerg Med. 2015;66(2):125-30.
doi:10.1016/j.annemergmed.2015.02.025…
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psnet.ahrq.gov/node/40209/psn-pdf
April 22, 2011 - The efficacy of computer-enabled discharge
communication interventions: a systematic review.
April 22, 2011
Motamedi SM, Posadas-Calleja J, Straus SE, et al. The efficacy of computer-enabled discharge
communication interventions: a systematic review. BMJ Qual Saf. 2011;20(5):403-15.
doi:10.1136/bmjqs.2009.034587.
…
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psnet.ahrq.gov/node/37570/psn-pdf
February 27, 2008 - Communication gaps and readmissions to hospital for
patients aged 75 years and older: observational study.
February 27, 2008
Witherington EMA, Pirzada OM, Avery A. Communication gaps and readmissions to hospital for patients
aged 75 years and older: observational study. Qual Saf Health Care. 2008;17(1):71-5.
doi:1…
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psnet.ahrq.gov/node/40195/psn-pdf
February 02, 2011 - Mock trial at 2009 RSNA annual meeting: jury exonerates
radiologist for failure to communicate abnormal
finding—but...
February 2, 2011
Berlin L. Mock trial at 2009 RSNA annual meeting: Jury exonerates radiologist for failure to communicate
abnormal finding--but.. Radiology. 2010;257(3):836-45. doi:10.1148/radiol.…
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psnet.ahrq.gov/node/50575/psn-pdf
October 23, 2019 - Dynamic pocket card for implementing ISBAR in shift
handover communication.
October 23, 2019
Schmidt T, Kocher DR, Mahendran P, et al. Dynamic Pocket Card for Implementing ISBAR in Shift
Handover Communication. Stud Health Technol Inform. 2019;267:224-229. doi:10.3233/SHTI190831.
https://psnet.ahrq.gov/issue/dynam…
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digital.ahrq.gov/sites/default/files/docs/page/ESTRIN_3_I.ppt
March 08, 2006 - Boards for HIE
Memphis RHIO Project Team
To be started Q1 2006
Working Groups
Planning and Management
Communications
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psnet.ahrq.gov/web-mm/patient-identification-errors-systems-challenge
February 23, 2011 - Instead, the name and MRN can be used during all communications and before transporting patients.